Death Rates In Medicare Patients Told

WASHINGTON — The death rates for Medicare patients nationwide last year show that 146 hospitals, or about 2.5 percent of the total, had a ``higher than expected``

mortality rate, a government study released Thursday shows.

Thomas Morford, director of the bureau of health-care quality and standards for the Health Care Financing Administration, which oversees Medicare, also noted that of the 6,000 short-term, acute-care hospitals in the survey, 183, or about 3 percent, had ``lower than predicted`` death rates in 1986.

The figures were released amid debate over whether they were anything more than ``random numbers,`` as one critic in the health care industry put it.

For the year, there were 735,000 deaths among the approximately 6.1 million Medicare hospital patients in the government study. There are about 31 million elderly or handicapped Americans who receive Medicare benefits.

The government declined to rank hospitals, as was done previously, or identify by name those that fell above or below the predicted rate, which was based on each hospital`s patient mix.

However, a review of the data on 240 hospitals in Illinois indicated that three hospitals, or about 1 percent, exceeded their predicted overall death rate, while three other hospitals had overall death rates that were lower than expected. The federal statistics also show the Medicare death rates for 16 categories of illnesses, such as cancer, stroke or severe chronic heart disease. No information was immediately available on the number of hospitals with especially high or low death rates for each category of illness.

Dr. William Roper, administrator of the Health Care Financing Administration, said the release of the survey signals an activist role by the federal government in pushing hospitals and physicians to measure the quality of medical care and to publish the results. ``This is a fundamentally new effort in the goverment`s role . . . an advocacy effort to inform the public,`` Roper said.

The death rate numbers ``will have an important spillover effect to all patients across the country,`` not only to the 31 million elderly and disabled Americans covered by Medicare, he said.

However, representatives of physician and hospital groups attacked the government figures as fatally flawed, charging that the calculation of the

``expected`` death rate fails to include a good measure of how sick a patient was before he reached the hospital.

The groups, including the American Medical Association and the American Hospital Association, also objected to the fact that the numbers attribute to a hospital the death of any patient who dies within 30 days of being discharged.

The 30-day period was chosen to prevent hospitals from lowering their mortality rate by quickly discharging patients on the verge of death, Roper said.

``They`re very close to being random numbers,`` countered Dr. Dennis O`Leary, president of the Joint Commission on Accreditation of Healthcare Organizations. The commission`s stamp of approval is accepted by the government as evidence that a hospital is good enough to participate in the Medicare program. ``The greatest importance of the release (of mortality figures) is its symbolic importance,`` O`Leary said.

In Illinois, the head of a federally funded group overseeing Medicare quality in the state said he questioned the meaningfulness of the information on the three state institutions that exceeded their predicted death rates-Oak Forest Hospital, funded by Cook County; the Illinois Veterans Home in Quincy, funded by the state; and Glendale Heights Community Hospital, affiliated with the Adventist church.

Both Oak Forest and the Illinois Veterans Home have acute-care wings, but are primarily designed for chronically ill, usually poor, patients with no place else to go. Because both institutions are ``a blend of a nursing home and a hospital,`` their death rates might be much higher than normal, said Thomas Hyngstrom, director of the Crescent Counties Foundation for Medical Care.

Hyngstrom said the high overall death rate for Glendale Heights hospital was attributed to problems in one category, pulmonary disease.

Dr. Kevin Smith, chairman of Glendale Heights` quality assurance program, said the hospital had reviewed its cases as a result of the government figures. He said that 9 of 10 of the patients cited had come from nursing homes and that they or their families had requested ``no heroic measures`` be taken to avoid death.

The three Illinois hospitals falling below the ``predicted`` death rate were Martha Washington in Chicago; Shelby Memorial in Shelbyville and St. Joseph`s in Breese.

Sister Mary Anthony, executive vice president of St. Joseph`s, said the 93-bed hospital`s success was probably due to the stability of Breese, with 3,800 people, and the surrounding Clinton County area of 25,000 people.

``We take care of the same kind of illnesses, plus we kind of take care of the same individuals,`` she said. ``We know the people in our area pretty well.``